Bloodletting, Lockdowns, and Other Adventures in Medical Theory

The term science as used over the years means two related but distinct and consistently confounded activities. The first and most ancient meaning: Science is an organized, systematic approach to a subject. Under this rubric are such modern fields as Political Science, most of Economics, and Philosophy, as well as Chiropractic Medicine, Astrology, and Scientology. The key is an organized, systematic approach. Such an approach appeals not to controlled experiment or repeatable observations, but merely to logic built upon certain more or less reasonable assumptions supported by a set of anecdotes. Sciences in this sense may or may not comport well with reality.

It is important to note that science in this first sense is often, maybe even generally, the best we can do, and can be useful. Economics is very useful, for example, even if it is supported almost entirely by a large (and convincing!) set of anecdotes. It has not been proven experimentally, for example, that socialist governments *must* *always* impoverish their subjects, but the lack of a clear counterexample sure does give one pause, to say the least.

The second sense, the sense in which Newton and Feynman are scientists in a way Machiavelli and Sun Tsu are not, rests on its claims working in the real world. Valid controlled experimentation and replicable observations *demonstrate* what they claim; technological applications of these claims reduce them to truths, albeit conditional truths in the physical world. Physics and Chemistry and related fields are sciences in this second sense.

BUT – here’s the huge caveat: saying Chemistry is a science is not the same thing as saying that everything any particular chemist claims is science. And, a little more subtly, there can be well-founded scientific claims embedded within the claims of areas that are science, generally, only under the first definition.

As discussed ad nauseum on this site, in fact, the main original reason I started blogging in the first place: We owe allegiance to and are morally obliged to accept, however conditionally, only the claims of science in the second sense. Why? Because science in the sense of a systematic study of a topic must be based on more or less credible assumptions. A reasonable person may reject those assumptions. Phrenology has a clear subject matter and a well-defined approach. All you have to accept is that the shape of a man’s skull tells you important things about his temperament and intelligence.

Does it? Now is where a little skill in science, what I call scientific literacy, comes into play: even with the meager science chops I have, it is easy to imagine what a valid scientific (in the second sense) study to determine the relationship between skull bumps and personality would look like. Double blind, large populations, carefully spelled out rules of observation and measurement, elimination, as far as possible, of judgement calls about temperament, off the top of my head. Then, once again based on my simply having read a bunch of science, the second part: if such a study existed, any serious Phrenologist would *lead* with that study, and all the follow up studies such an interesting and useful science would of course generate.

But they don’t. Therefore, fraud, or at least, self-delusions.

The situation becomes more murky when there is plenty of anecdotal evidence to support claims, such as the innumerable people who will testify that probiotics or homeopathy have healed them. Good people of good will, no doubt. But do they? I don’t see anything like valid scientific studies to support these and many similar claims. If they existed, anybody steeped in science in the second sense would lead with them.

But they don’t. Does this mean they are wrong? No. It simply means an honest man owes them no allegiance, and that a scientifically literate man is all but compelled to note the lack of any real science to support the claims. If science in the second sense is being claimed, then a scientifically literate man is obliged to call foul.

Mostly, I assume, and it generally seems to be the case, that there’s little if any harm in most such claims. Go on a keto diet and get you probiotics from a tube, if you want, certainly none of my business. But sometimes…

And – a lot of other such stories. What I want to talk about today is that even radium water was supported by anecdotes and scientific theories. That golfer who died from drinking radium water – recommended by his doctor! – spent years telling anybody who would listen how good it was for him, improved his energy, and all in all made him feel great – right up until cancer rotted his bones out.(1) And the manufacturer had a theory – Radiation hormesis – that sounded pretty good to many people. It sounded like science, and, being scientifically illiterate, the average Joe doesn’t even know the right questions to ask.

Back to bloodletting. It’s customary to think doctors back in the old days were really stupid – bleeding people, thinking intentional blood loss was going to cure them? When bloodletting was done enough, it in itself would kill you! How stupid do you have to be?

Not stupid at all, it turns out. Doctors well into the 19th century still used it.

They had a theory. They still do. Some patients did recover, and, no doubt, credited the bloodletting as the cure to all who would listen. The nice doctor would tell the poor sick person they needed bloodletting with stone certainty; friends and relatives might testify to its effectiveness.

But those ignorant days are past, right? Doctors today rely on science in the second sense, well-understood, thoroughly tested practices supported by multiple rigorous studies…

Unfortunately, nope. For example, we older people are often prescribed several drugs at the same time. Drugs have a range of effects on people; few are universally effective: some people respond as advertised, but some just don’t respond for reasons that are poorly understood, if understood at all. And drugs interact. Sometimes, the interactions are well known, usually because they killed a number of people. Failing that, it’s unlikely that the drug interactions have been studied at all, let alone subjected to rigorous, scientifically valid research.

Think about it: a drug company spends many millions of dollars getting a drug tested. All in, it takes in the neighborhood of a billion dollars to get a drug to market. That drug – any and every drug – may and probably will be used in conjunction with any number of other drugs (and alcohol, pot, and goodness knows what else). To *scientifically* answer the question: how does this drug interact with aspirin? Tylenol? Blood pressure meds? Serotonin uptake inhibitors? and on and on, would take billions and billions of dollars. And then how about with both blood pressure meds and antidepressants together? And so on.

To require the level of testing to determine the risks (and, who knows? benefits) of combining multiple drugs would simply put the drug companies out of business. No one could afford the level of testing needed to figure all this out. No more new drugs for you! (2)

Thus, when people say medicine is more art than science, they ain’t kidding.

The topical application of all this: doctors are trained and formed in this world. They are not, and, insofar as they are practicing in the real world, cannot be, scientists in the second sense.

So, we are assured – we were, weren’t we? – that lockdowns were needed, because science! Nope, no science was involved – doctors had a theory, like they had with bloodletting and radium water. You think there are rigorous scientific studies proving lockdowns, on the whole, improve things? Has anyone even dared propose that such studies exist? Social distancing save lives! It’s science! 6 feet! 5 feet doesn’t cut it, and 7 feet is clearly excessive! Nope. Somebody has a theory, like ringing church bells to disperse the aqueous humors causing the Plague (it was perfectly logical science, in the first sense of the word).

Bottom line: at best, an increasingly credulity-defying position to hold, lockdowns and social distancing were reasonable guesses based on some untested and unverified theory held by doctors, doctors who are not scientists and are as likely as anybody else to be scientifically illiterate. No overall assessment of risk was performed, as in, do the likely costs of lockdowns and social distancing exceed the assumed, theoretical, benefits?

Nope. It’s theories all the way down – at best. No real science involved, nothing that would compel an honest, scientifically literate man to assent to these measures. More likely, it’s political corruption refusing to let a crisis go to waste, even if they have to manufacture the crisis.

It is so clear now that the costs of lockdowns and social distancing exceed by far any benefits that it is sheer evil perversity that any remain in effect. We need to explore ways to make the panic mongers and political operative pay.

1. As the Wall Street Journal put it: “The Radium Water Worked Fine Until His Jaw Came Off”
2. Whether this would necessarily be a bad thing overall is an open question. It has to be!